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Measuring outcome in the treatment of depression via the Web

Rhode Island Hospital finds Web-based assessment reliable, valid and feasible



IMAGE: A new study from Rhode Island Hospital led by Mark Zimmerman, M.D., reports that Web-based assessments for outcome measurements of patients in treatment for depression are valid and reliable and... view more

Credit: Rhode Island Hospital

PROVIDENCE, R.I. - A newly published paper from Rhode Island Hospital reports that Web-based assessments for outcome measurements of patients in treatment for depression are valid and reliable. The findings indicate that the Internet version of the depression scale was equivalent to the paper version, and that patients preferred the Internet version. The paper is published in this month's edition of the Journal of Clinical Psychiatry.

Lead author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital, and his colleagues studied 53 psychiatric patients receiving ongoing outpatient treatment for depression. Patients were given a questionnaire in both paper and online form. The questionnaire was developed by the team, and is a brief measurement tool that can be quickly scored and is considered clinically useful and reliable. By having patients respond to both versions of the questionnaire, the research team was able to compare the validity of the results, while also asking open-ended questions of the patients to determine which form they preferred.

Zimmerman says, "With the growing interest in developing electronic medical records, together with the increased pressure to adopt measurement-based care in clinical practice, the time is right to develop a Web-based system to monitor depression in clinical practice."

The researchers found that the consistency of the paper and Internet administration of the questionnaire was high. They also found that patients preferred to complete the scale on the Internet. Patients reported that it was viewed as less burdensome, less time consuming, more secure, and even more accurate and valid.

Zimmerman reports, "Web-based administration of outcome assessments offers several potential advantages over paper-and-pencil assessments. They are convenient for patients, there is a reduced cost associated with them, they can be scored automatically and data can easily be aggregated. Also, computerized questionnaires can also prompt patients to answer all questions, thereby reducing missing data."

The researchers conclude that the results of the study support the reliability and validity of Internet administration of outcomes measurement for depression. Zimmerman concludes, "We believe that a Web-based system for measuring outcome can enhance capabilities for longitudinal tracking of the course of this often chronic disorder. Another advantage is that it provides an inexpensive method for data aggregation, and patients prefer it." The website,, is free to both patients and clinicians.


Zimmerman's principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island. The researcher also has an academic appointment at The Warren Alpert Medical School of Brown University. Jennifer Martinez, BA, also of Rhode Island Hospital and Alpert Medical School, is a coauthor of the paper.

About Rhode Island Hospital:

Founded in 1863, Rhode Island Hospital in Providence, RI, is a private, not-for-profit hospital and is the largest teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Rhode Island Hospital receives nearly $50 million each year in external research funding. For more information on Rhode Island Hospital, visit

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